Late PCI and CABG for secondary intervention are associated with decreased MACE in patients with multivessel disease after successful primary PCI

Background Incomplete ST-segment deviation resolution (STR) after epicardial flow restoration may represent microvascular dysfunction and predicts an unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). From recently published data concerning STEMI patients that underwent primary percutaneous coronary intervention (PCI), increased mortality in patients with multivessel disease (MVD) was attributed to the presence of a chronic total occlusion (CTO) in a non-infarct-related artery (IRA). We evaluated whether the presence of MVD with or without a CTO in a non-IRA significantly contributes to incomplete STR in a large cohort of patients undergoing primary PCI for STEMI. Methods In this single-center study, 2127 STEMI patients underwent primary PCI between 2000 and 2006. The IRA and presence of MVD was determined during diagnostic angiography preceding primary PCI. MVD was assessed if ≥ 1 non-IRA showed ≥ 1 coronary stenosis of ≥ 70% and a CTO was defined as a 100% luminal narrowing in a non-IRA. STR was defined as the relative difference (in %) of the summed ST deviation between the pre-PCI and the immediately post-PCI 12-lead ECG. A post-PCI STR of ≥ 70% was considered complete. Results During emergency coronary angiography, singlevessel disease (SVD) was observed in 1474 (69.3 %) patients, MVD without a CTO in 433 (20.4 %) patients, and MVD with a CTO in a non-IRA in 220 (10.3 %) patients. MVD patients less frequently showed complete STR compared to patients with SVD (OR 1.2 95% CI, 1.0 – 1.5 p = 0.046). However, the occurrence of complete STR in SVD patients and MVD patients without a CTO was comparable (OR 1.1, 95% CI, 0.9 – 1.4 p = 0.43). In MVD patients with a CTO, STR was significantly less often complete compared to patients with SVD or with MVD without a CTO (OR 1.6 95% CI, 1.1 – 2.6 p = 0.01). Conclusion STEMI patients with MVD undergoing primary PCI showed complete STR less often compared to SVD patients. This effect is mainly due to a subgroup of MVD patients with a CTO in a non-IRA and not due to mere MVD.

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TCT-18: Prognostic Impact of Staged vs. “One-Time” Intervention for Multivessel Disease During Primary PCI in STEMI: Insights from the HORIZONS-AMI Trial

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.08.024 ◽

2009 ◽

Vol 104 (6) ◽

pp. 8D ◽

Cited By ~ 1

Keyword(s):

Multivessel Disease ◽

Prognostic Impact ◽

Primary Pci

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Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design

EuroIntervention ◽

10.4244/eijv8i10a183 ◽

2013 ◽

Vol 8 (10) ◽

pp. 1190-1198 ◽

Cited By ~ 32

Author(s):

Damian J. Kelly ◽

Gerald P. McCann ◽

Daniel Blackman ◽

Nicholas P. Curzen ◽

Miles Dalby ◽

...

Keyword(s):

Multicentre Trial ◽

Management Strategies ◽

Multivessel Disease ◽

Primary Pci ◽

Culprit Lesion ◽

Trial Testing ◽

Testing Management

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IMPACT OF IMMEDIATE MULTIVESSEL INTERVENTION ON OUTCOME OF PATIENTS WITH MULTIVESSEL DISEASE UNDERGOING PRIMARY PCI FOR CARDIOGENIC SHOCK IN REAL LIFE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)61697-6 ◽

2013 ◽

Vol 61 (10) ◽

pp. E1697

Author(s):

Uwe Zeymer ◽

Mathias Hochadel ◽

Harald Darius ◽

Johannes Brachmann ◽

K. Hauptmann ◽

...

Keyword(s):

Cardiogenic Shock ◽

Real Life ◽

Multivessel Disease ◽

Primary Pci

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Preliminary Report on the Safety and Efficacy of Staged versus Complete Revascularization in Patients with Multivessel Disease at the Time of Primary Percutaneous Coronary Intervention

International Journal of Angiology ◽

10.1055/s-0036-1572522 ◽

2016 ◽

Vol 26 (03) ◽

pp. 143-147 ◽

Cited By ~ 1

Author(s):

Ahmed Rashed ◽

Wael El-kilany ◽

Mohamed El-Haddad ◽

Islam Elgendy ◽

Marwan Saad

Keyword(s):

Percutaneous Coronary Intervention ◽

Type A ◽

Coronary Intervention ◽

Multivessel Disease ◽

Fluoroscopy Time ◽

Complete Revascularization ◽

Primary Pci ◽

Safety And Efficacy ◽

St Segment Elevation ◽

Percutaneous Coronary

This study aims to determine the safety and efficacy of complete versus staged-percutaneous coronary intervention (PCI) of nonculprit lesions at the time of primary PCI in patients with multivessel disease. Recent trials had suggested that revascularization of nonculprit lesions at the time of primary PCI is associated with better outcomes, however; the optimum timing and overall safety of this approach is not well known. An observational prospective study was conducted, including 50 patients who presented with ST-segment elevation myocardial infarction and found to have at least an additional nonculprit significant (> 70%) type A or B lesion. According to the operator's discretion, patients either underwent complete revascularization of nonculprit significant lesions during primary PCI procedure or within 60 days of primary PCI (staged-PCI). Safety outcomes evaluated were contrast-induced nephropathy (CIN), the amount of contrast used, and fluoroscopy time. Efficacy outcome assessed was major adverse events (MACE) at 1 year. The fluoroscopy time and amount of contrast used were increased in complete revascularization group (35.3 ± 9.6 vs. 26.3 ± 6.7 minutes, p < 0.001, and 219.5 ± 35.1 vs. 187.5 ± 45.5 mL, p = 0.01, respectively); while incidence of CIN remained similar (p = 0.73). The incidence of MACE at 1 year was similar in both groups (23% in the complete revascularization group vs. 25% in the staged-PCI group, p = 0.43). Complete revascularization and staged-PCI of nonculprit type A or B lesions at the time of primary PCI were associated with similar long-term outcomes and safety profile. Larger studies are needed to further validate these results.

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